公立医院改革，改制将全面试点

As long-anticipated reforms to the medical sector continue to roll on, the State Council announced on May 17 that private investment will be permitted for some public hospitals. The move is part of an expansion for a 2010 pilot program which mandated an overhaul of the country’s 6,800 hospitals in urban areas by 2017. Participating hospitals have not been chosen, according to the announcement. Under the program, public hospitals have been required to raise the quality and prices of services to generate income. Income generated from prescription drugs has now been capped at 30 percent, a limit that once stood between 35 and 50 percent. The drug mark-up limits have generated debate on how hospitals will make up for the funding shortfall. Liao Xinbo, an official from the health commission in the southern province of Guangdong said the move has raised concerns on service affordability for patients. He said, "The abolition of the drug mark-up, which is otherwise aimed at addressing soaring medical costs, might just end up resulting in more burdens for hospitals and patients." Director of the Center for Public Policy at the Chinese Academy of Social Sciences Zhu Hengpeng said that while private investment in hospitals is expected to lower medical costs, the country has no rules for evaluating intangible assets of public hospitals. Price hikes in medical services have generated public uproar in recent months. In March a plan by officials in Chongqing to double the cost of dialysis was scrapped when some 1,000 patients launched a street demonstration. For Caixin Online, this is Diana Bates. 城市公立医院改革一直被看做2009年启动的新一轮医改最大的难点，此前仅在少数城市进行试点。而根据国务院方面的最新方案，至2017年改革试点将扩大到全国。 5月17日，国务院办公厅在中国政府网发布《关于城市公立医院综合改革试点的指导意见》（下称《意见》），在破除以药补医机制、推动分级诊疗、深化医保支付改革等方面提出具体目标。 目前中国有6800家城市公立医院，是医疗服务体系的主体。“这些公立医院的改革是医改中最难啃的’硬骨头’。”国务院医改办表示。 2010年初，国家在17个城市启动公立医院改革试点，2014年试点城市扩大到34个，2015年增加到100个，并在《意见》当中要求在2017年所有地级以上城市都将全面推开公立医院综合改革试点。 无论是城市公立医院改革还是县级公立医院改革，都将破除以药养医列为改革的重中之重。同时，方案仅允许“公立医院资源丰富的城市，可选择部分公立医院引入社会资本进行改制试点” 《意见》要求改变公立医院收入结构，提高业务收入中技术劳务性收入的比重，降低药品和卫生材料收入的比重。力争到2017年试点城市公立医院药占比（不含中药饮片）总体降到30%左右；百元医疗收入（不含药品收入）中消耗的卫生材料降到20元以下。 此外，《意见》还提到“公立医院资源丰富的城市，可选择部分公立医院引入社会资本进行改制试点，加强有形资产和无形资产的评估，防止国有资产流失。” 中国社科院公共政策研究中心主任朱恒鹏认为，如果做好这点，将降低改制成本。然而难点在于，目前并没有对事业单位无形资产评估的完善办法。作为国有资产的具体管理部门，应尽快出台政策，制定对公立医院的资产评估办法，并进行试点。 常活跃在网络平台抒发己见的广东省卫计委巡视员廖新波指出，取消以药补医后，大部分医院资金的缺口是由政府造成的，各级财政都没能补上。在在这样的情况下，医院为了生存，也就衍生出类似于“以检补医、以检补药”的医疗行为。“到头来，如此的取消以药养医非但没有缓解群众’看病难、看病贵’的问题，反倒加重了医院和患者的负担。”